Provider Demographics
NPI:1184192031
Name:NIXON, VAUGHN OSMUND JR (NEUROMUSCULAR THERAP)
Entity Type:Individual
Prefix:PROF
First Name:VAUGHN
Middle Name:OSMUND
Last Name:NIXON
Suffix:JR
Gender:M
Credentials:NEUROMUSCULAR THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MANOR DR STE E
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1958
Mailing Address - Country:US
Mailing Address - Phone:650-219-1393
Mailing Address - Fax:
Practice Address - Street 1:110 SUMMERRAIN DR
Practice Address - Street 2:
Practice Address - City:S SAN FRAN
Practice Address - State:CA
Practice Address - Zip Code:94080-3281
Practice Address - Country:US
Practice Address - Phone:650-219-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist